Common Eye Conditions

Please read this important information before proceeding further: 

This information is not intended to replace the professional examination and diagnosis of a physician, and they are presented here purely for informational purposes.

All possible diagnoses and treatment options are not covered, and the information discussed should not be taken as a recommendation to self-diagnose and self-treat a condition. A misdiagnosed or improperly treated eye condition can result in a permanent loss of vision, or a permanent loss of function of the eye or visual system. In the case of any eye problem, seek medical attention promptly. This can include emergency room treatment, as well as treatment by a medical physician or eyecare provider.

Click on the name of the condition below that you wish to read, or scroll down the page. To read the Acrobat files below, you will require the free Adobe Acrobat Reader

Blepharitis
Blepharoplasty
Blocked Tear Ducts
Cataract Surgery
Congenital Rubella Eye Effects (Adobe Acrobat .pdf file)
Electrolysis
Eyelid Disorders (Adobe Acrobat .pdf file) 
Floaters and Flashes
Glaucoma
How The Eye Works (Adobe Acrobat .pdf file) 
Iritis
Keratoconus
Ptosis Surgery
Refractive Surgery
Thyroid Eye Disease 

BLEPHARITIS

Blepharitis is a chronic inflammation of the eyelid margins around the eyelashes.  It causes soreness, redness and irritation of the eyelid margins.  There is a fine powdery deposit of scales around the lashes which tend to fall into the tears.

There is no cure for this condition, but a few simple measures will help keep it under control, the lid cleansing directions below, possibly application of an antibiotic ointment to the lid margins.  Sometimes tablets are prescribed.

Preparation of the Solution
Mix one teaspoon of Sodium Bicarbonate with one pint of boiling water, allow to cool. Store the solution in a clean container with the lid on.  After one week, discard the solution. Alternatively, Johnson's Baby Shampoo well diluted or mixed in the same proportions as above may be used instead.

Method of Application
Dip cotton bud into the solution and carefully clean the upper and lower eyelid margins of both eyes in front of a mirror,  taking care not to allow the solution to enter the eyes.  Use a fresh cotton bud each time and discard after use.

Repeat the method twice daily.  When the procedure is completed, drops/ointment may be applied to the lid margins as instructed, if prescribed.  If tablets have been prescribed, then you should take them as directed. This treatment will help in the reduction of the inflammation of the eyelids.

BLEPHAROPLASTY
There are many causes of unusually shaped eyelids including congenital or traumatic, but usually sagging skin over the eyelid is the problem, which happens to all of us in time to some degree!  Blepharoplasty is the name given to an operation in which the shape of the eyelids is addressed .  In some cases, the whole brow may droop (brow ptosis) and this may also need to be addressed. Sometimes, there is also fat which needs to be removed, along with skin. Unless the eyelids are drooping enough to obstruct the vision, this is usually considered a cosmetic procedure.

BLOCKED TEAR DUCTS
A lacrimal duct obstruction is blockage of the tear duct, the thin channel that normally drains tears from the surface of the eye.  A tiny hole at the inner edge of each eyelid marks the opening of the ducts, which lead to the lacrimal sacs located on the side of the nose. The tears pass from the sacs into the nasolacrimal ducts and then into the nose.

When a tear duct becomes obstructed, tears may spill over the eyelids and run down the face. Stagnant tears within the system can become infected, leading to recurrent red eyes and infections. Excessive tearing can also produce secondary skin changes on the lower eyelids.

Children frequently have a congenital lacrimal duct obstruction. Six to ten percent of all children are born before their tear ducts are open. In adults, a common cause of lacrimal duct obstruction is involution, which is progressive degeneration occurring naturally with advancing age, resulting in shrivelling of organs or tissues. Other causes include eyelid disorders, infections by bacteria, viruses, fungi, and parasites, inflammations, the use of eye drops or excessive nasal spray, systemic chemotherapy, trauma from previous surgeries, injury to the bone at the side of the nose, foreign bodies, sinus disease, nasal polyps, and malignant or benign tumors.

Diagnosis
If the primary symptom is excessive tearing, the first step is for the health care professional to determine if the overflow of tears is due to an increase in tear production or a decrease in tear drainage. Causes of increased tear production may include trichiasis, a disease in which the eyelashes produce constant irritation, and eyelid malpositions and diseases. If abnormal tear production is ruled out, then obstructions in tear drainage is the most likely cause of the excessive tearing. Additional observations of swollen lacrimal sac area and purulent eye discharge indicate that there may be a lacrimal duct infection present. To further define the diagnosis, the lacrimal discharge may be cultured to determine possible infective agents, while various imaging techniques may be used to detect the type of obstruction. Dye tracer tests are also used to test for blockages.

Treatment
Lacrimal duct obstructions in children often resolve spontaneously, with 95% showing resolution before the child is one year old. Daily massaging of the lacrimal sac may help open the blockage. A topical antibiotic ointment may be applied if infection is present. If the blockage is not resolved after several weeks to months of this therapy, a physician may attempt forceful irrigation. Surgical probing to open up the duct under anesthesia is a last resort, after a year or so of less invasive treatments. 

ELECTROLYSIS
This can be performed to permanently remove eyelashes which are growing in the wrong direction (trichiasis) which can otherwise be a very uncomfortable and even damaging situation. It is performed in the clinic under local anasthesia.

FLOATERS
Most people, as they age, see small dark shapes that appear to float in their field of vision, similar to a fly, flying around.  These are called floaters.  They are usually more obvious against a clear background, moving quickly with eye movement and drift away when eye movement stops.

They are particles in the vitreous body – the jelly-like substance that fills the eye.  The vitreous body is attached to the retina – the layer of light sensitive tissue at the back of the eye. Floaters appear in the field of vision because they cast shadows on the retina.

Some floaters are barely noticeable, while others can severely interfere with vision.  Though they are annoying, floaters are usually harmless and can come and go over the years.

FLASHES
These can be seen with, or without floaters.  Flashes of light that may last for a few seconds or several minutes and can occur off and on for weeks or months.  The vitreous body can shrink as part of the ageing process and when this happens a large floater and multiple flashes are usually seen.

Sometimes the vitreous body is more firmly attached and as it pulls away from the retina, can take a piece of the retina with it.  This can cause slight bleeding and fluid can escape, pushing the retina off the inside wall of the eye.  This is known as a retinal detachment, which is a serious threat to vision.  A surgical procedure is required to reattach the retina.

For this reason symptoms of flashing lights do need to be checked as soon as possible.

GLAUCOMA
Glaucoma is an abnormal increase of pressure within the eye (intraocular pressure – IOP) which may result in optic nerve injury and affect the vision.  As pressure in the eye builds up, there is a progression from mild visual impairment, and if left unchecked can lead to blindness. Glaucoma can develop later in life as a result of cataract surgery.

Signs and symptoms to look out for include:

• loss of peripheral vision
• pain in the eye
• redness of the eye
• increased rubbing of the eye
• misty rainbow coloured rings can be seen around white lights

An optometrist can perform several tests to check for glaucoma.  If glaucoma is identified, it can be managed with the daily use of eye drops. For more detailed information, click here.

IRITIS
This is an inflammatory problem of the iris (the coloured part of the eye), also called anterior uveitis.  It often occurs for many unknown reasons but it may be linked to systemic diseases (or so-called connective-tissue diseases) affecting the body, infections, injury or previous eye surgery.

Symptoms/Signs
- Red eye
- Light sensitivity (photophobia)
- Pain; ranging from aching or soreness to intense discomfort
- Small pupil
- Tearing/watering

Diagnosis/Treatment
The doctor can detect iritis looking at the eye with a slit-lamp microscope, looking for, amongst other things, tiny white cells floating in the eye – these are a sign of inflammation.  In addition to an eye examination, you may be asked to undergo blood tests and a complete physical examination.  Your complete medical history and current medications should be made known to your ophthalmologist to aid diagnosis.

To reduce inflammation in the eye, steroids and anti-inflammatory eye drops will be prescribed.  Dilating drops may also be prescribed to relax the muscle constricts the pupil, to make the eye more comfortable. It is a recurring disease and must be treated promptly, not only to relieve symptoms, but to avoid scarring and sight loss.

Helpful websites to visit: www.iritis.org

KERATOCONUS
Is a progressive disorder that thins the normally round dome-shaped cornea (the clear convex structure that forms the front of the eye) and causes a cone-like bulge to develop. This results in significant visual impairment. The cornea is the clear window of the eye and is responsible for refracting most of the light coming into the eye. Therefore, abnormalities
of the cornea severely affect the way we see the world making simple tasks, like driving, watching TV or reading a book difficult.
 
Onset of keratoconus is usually in the teenage years, very rarely after 30 years of age.  There has been no evidence of gender predisposition and in around 90% of cases affects both eyes.  Keratoconus also runs in families.  In its earliest stages, keratoconus causes slight blurring and distortion of vision and increased sensitivity to glare and light.  The disease process is active for about 5-10 years, then it may be stable.  During the active stage, change can be rapid.  Diagnosis of the second eye usually lags about five years after the first.

Initially eyeglasses or soft contact lenses may be used to correct the mild nearsightedness and astigmatism that is caused in the early stages of keratoconus. As the disorder progresses and the cornea continues to thin and change shape, rigid gas permeable contact lenses can be prescribed to correct vision more adequately. The contact lenses must be carefully fitted, and frequent checkups and lens changes may be needed to achieve and maintain good vision. 

In severe cases, a corneal transplant may be needed due to scarring, extreme thinning or contact lens intolerance. This is a surgical procedure that replaces the keratoconus cornea with healthy donor tissue.  In New Zealand the New Zealand National Eye Bank collects and stores corneal tissue to distribute to corneal surgeons for grafting.

Websites that may be of interest are:
www.contactlens.org.nz/kerato.htm
www.roseklens.com
www.kcenter.org
www.nkcf.org

PTOSIS SURGERY
Ptosis is the generally used short name for blepharoptosis, which means a drooping eyelid. This may have a number of causes, but is usually due to a breakdown in the connections between the muscles which are meant to lift the eyelid, and the lid itself. In these cases, reattachment of the connections is possible.  This can usually be done under local anaesthetic as a day case procedure.

The thyroid is a small gland situated in the neck. Its function is associated with the body's use and turnover of energy. The thyroid can be underactive (hypothyroidism) or overactive (hyperthyroidism).

Signs and symptoms to look out for include:

Hypothyroidism	Hyperthyroidism
- Mental and physical slowness  - Weight gain  - Cold intolerance - Constipation - Dry skin  - Lethargy - Memory loss - Heavy periods  - Hoarse voice  - Swollen eyes  - 'Dull' hair	- Fast pulse - Hand Tremor - Weight loss - Heat intolerance  - Diarrhoea  - Excessive sweating  - Decreased need for sleep  - Anxiety and becoming increasingly emotional  - Protrusion of the eyes

If any of the above symptoms are being experienced, these should be discussed with the individuaI's GP. The GP may ask some questions and decide to do a blood test. Thyroid dysfunction can be detected by measuring levels of hormone in the blood. Again, there is no cure but careful monitoring and treatment means thyroid disorders can be managed very successfully.